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Primary repair of esophageal atresia in extremely low birth weight infants: a single-center experience and review of the literature.

Authors
  • Seitz, Guido1
  • Warmann, Steven W
  • Schaefer, Juergen
  • Poets, Christian F
  • Fuchs, Joerg
  • 1 Department of Pediatric Surgery, University Children's Hospital, Tübingen, Germany. [email protected] , (Germany)
Type
Published Article
Journal
Biology of the neonate
Publication Date
Jan 01, 2006
Volume
90
Issue
4
Pages
247–251
Identifiers
PMID: 16785729
Source
Medline
Language
English
License
Unknown

Abstract

Advances in neonatal intensive care have led to an increased survival of very low birth weight (VLBW, <1,500 g) and extremely low birth weight infants (ELBW, <1,000 g). Several abnormalities may occur in these children, e.g. esophageal atresia (EA), imperforate anus or abdominal wall defects. Correction of EA is often performed as a staged procedure in this group of patients. To evaluate the feasibility of a primary correction of EA in 4 ELBW and VLBW infants. Between 2002 and 2004, 4 infants below 1,200 g were operated on in our institution with a diagnosis of EA with lower tracheoesophageal fistula. Birth weight ranged from 780 to 1,120 g (median: 920 g), gestational age from 28 to 30 weeks. Treatment included closure of the tracheoesophageal fistula and primary anastomosis of the esophagus in a one-step procedure. Primary correction of EA and fistula repair was feasible in all children. Initially, all children had a normal passage of the esophagus as observed in barium swallowing. One child suffering from a leakage of the anastomosis was managed conservatively. Another infant suffered from spontaneous small bowel perforation 6 days after surgery, which was treated by laparotomy. One child developed stenosis of the esophagus and required a single dilatation 14 months after initial treatment. In the 4th child, a type II cleft syndrome was subsequently diagnosed, requiring secondary cleft repair together with semifundoplication. This child eventually died from cytomegalovirus pneumonia. Primary repair of EA and closure of a tracheoesophageal fistula is technically feasible and offers a good treatment option for ELBW and VLBW infants. Staged repair can be avoided. Infants with cleft syndrome are still a diagnostic and therapeutic challenge. Copyright (c) 2006 S. Karger AG, Basel.

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